School Psychologists as Mental Health Providers: The Impact of Staffing Ratios and Medicaid on Service Provisions

Abstract

As one out of five children in the United States demonstrate some type of mental or behavioral health concern warranting additional intervention, federal policies have emphasized the need for school‐based mental health (SBMH) services and an expansion of Medicaid reimbursement for eligible children and families. Most youth access mental health services at school; therefore, it is important to evaluate how staffing ratios, credentialing, and state Medicaid policies may influence school psychologists’ involvement in the delivery of SBMH services. A survey of 192 school psychologists found that as practitioner to student ratios increased, the availability and provision of SBMH services decreased. As state Medicaid policies have been found to influence the provision of mental health services at school, current study results demonstrate an association between state level Medicaid policies and the number of school psychologists qualified to bill for Medicaid‐reimbursable services. Implications for service delivery and policy development are discussed.

Examining the role of school psychologists as providers of mental and behavioral health services

“…Furthermore, as student ratios increased, the number of MBH hours decreased. These results suggest that school psychologists who work in multiple schools and/or those who are in larger schools may not have the time to provide targeted MBH services, aligning with previous findings (Eklund et al, ). As schools are the most common setting for students to access MBH services (Farmer et al, ; NASP, ), these findings raise doubts about the extent to which school psychologists are able to contribute to these services, and likewise the accessibility of MBH services to students in need.…”

“…Given the wide range of responsibilities school psychologists face within schools, it can be difficult to manage multiple demands across assessment, intervention, and consultation services. Furthermore, previous and current study results support the notion that the higher the ratio of school psychologists to students, the fewer hours these practitioners will have to support MBH services in their regular practices (Eklund et al, ). As such, it would prove beneficial for school psychologists to work in tandem with administrators to clearly articulate role expectations and how these can be aligned to meet the needs of the school community at large.…”

“…Additionally, although the current investigation was primarily focused on the engagement in a broad range of MBH services, recent findings suggest school psychologists spend the majority of their time on legally mandated services (e.g., psychoeducational evaluations and special education eligibility; Walcott & Hyson, ) and may not have a job description that prioritizes or even acknowledges their critical involvement in MBH services (Suldo et al, ). It is also plausible that in many schools, MBH services may be provided by another school‐ or community‐based provider (e.g., school counselor and social worker; Eklund et al, ), suggesting a need for practitioners to engage in ongoing collaboration and consultation in the provision of MBH services. Current data suggests that additional school‐employed mental health professionals are needed to address the ongoing mental health needs of students.…”

“…Nevertheless, several barriers limit school psychologists' ability to provide a comprehensive range of services. This includes a focus on special education-related activities such as assessment and eligibility determination, school psychologist-to-student ratios that far exceed the national recommendation of one to 500-700 students, prioritization of academic achievement over mental health, and inadequate funding (Curtis, Hunley, & Grier, 2002;Eklund, Meyer, Way, & Mclean, 2017;Fagan & Sachs Wise, 2007;Gilman & Medway, 2007;Hanchon & Fernald, 2013;Suldo, Friedrich, & Michalowski, 2010). State or local education agencies may provide school psychologist job descriptions that do not include providing mental health services.…”

A case example of one state's efforts to measure and address the critical shortage of school psychologists

“…Although correlation does not imply causation, these data, combined with school psychologists' traditional gatekeeper role to special education (Fagan and Wise, 2007;Fagan, 2014), indicate that school psychologists may be relegated to more traditional psychoeducational evaluation duties if required to serve greater numbers of students. In fact, recent research indicates that, as the ratio of students to school psychologists increases, the availability and provision of critical mental health services by school psychologists decrease (Eklund, Meyer, Way & Mclean, 2017). In addition to limitations in service provision, school psychologists are reporting exceptional work MANN ET AL. | 1717 demands coupled with insufficient time and resources to meet those demands (Boccio, Weisz, & Lefkowitz, 2016).…”